DR. RICHARD CARMONA: The debate is over. It causes disease and kills people.

JIM LEHRER: Now, why do you say that? What evidence do you have that this actually does kill people?

DR. RICHARD CARMONA: The first report on this subject was issued by one of my predecessors in 1986. In the 20 years after that, there have been hundreds of research papers that have come out, original research being done, to delineate the connection between certain risk factors and secondhand smoke.

It is clear now that we have enough science to say that it causes significant disease, as well as death, across the board, from birth to the senior population.

JIM LEHRER: The figure you used today in your report was 126 million Americans. Where does that come from?

DR. RICHARD CARMONA: A hundred and twenty six million Americans are exposed to secondhand smoke. That’s an estimate. And we’re concerned because, every day that they’re exposed, it’s another day toward added risk for disease, cardiovascular disease, cancer, lung disease.

This is a very significant problem. It adds to a huge disease burden in our society and an economic burden, as well.

JIM LEHRER: Where does the major exposure come?

DR. RICHARD CARMONA: Well, it really depends on what age group you’re in. Interestingly enough, children’s exposure is primarily in the home with their loved ones smoking around them, and that’s a very…

JIM LEHRER: Mom and dads smoke, the kids…

DR. RICHARD CARMONA: Mom and dad, aunts and uncles, grandma, grandpa, but family in a home where children are exposed.

JIM LEHRER: How in the world are you going to stop that?

DR. RICHARD CARMONA: Well, education, we hope. We hope this information will get out and empower people to start thinking. I mean, a lot of people think, “Well, it’s secondhand smoke. It’s really not that worrisome. The kids will do fine.”

The fact is: They won’t. We have evidence now that every day a child is exposed to secondhand smoke, they have higher incidents of asthma. Eventually, they’ll develop cardiovascular disease and cancers over time.

JIM LEHRER: And that has actually been traced and proven?

DR. RICHARD CARMONA: Yes, the secondhand smoke relationship has been proven in certain areas. There are some areas that are still gray. We’re not actually absolutely sure, you know, on aneurysm, vascular disease, but certainly for heart attacks and coronary disease, no question, unequivocally related to the disease, secondhand smoke.

Make homes smoke-free

Dr. Richard Carmona

U.S. Surgeon General

What I'm trying to do is appeal to parents and say, "Look, we all love our children." Forget I'm the surgeon general. I'm the father of four children, too. What I'm saying to you is you're harming your children if you continue to smoke around them.

JIM LEHRER: All right, now, you want parents -- obviously, you want them to quit smoking, but if they're not going to quit smoking, what do you want them to do, go outside in their backyards?

DR. RICHARD CARMONA: Absolutely. Absolutely.

JIM LEHRER: Literally go out of their homes?

DR. RICHARD CARMONA: Absolutely. Well, what I'm trying to do is appeal to parents and say, "Look, we all love our children." Forget I'm the surgeon general. I'm the father of four children, too. What I'm saying to you is you're harming your children if you continue to smoke around them.

If you have to quit, if you're struggling to quit, go outside. Make your home a smoke-free environment so your children don't suffer these consequences of secondhand smoke.

JIM LEHRER: What about in cars, in privately owned cars, same message?

DR. RICHARD CARMONA: Same message. Same message. In privately owned cars, in the workplace, any place, we need to work to creating smoke-free environments, because secondhand smoke is a significant hazard in our culture, every day.

JIM LEHRER: Now, you want smoking banned in all public places?

DR. RICHARD CARMONA: Well, I'm not using the word "banned." What I'm hoping to do is to be able to...

JIM LEHRER: If you could ban it, would you ban it?

DR. RICHARD CARMONA: Well, really it's not my job to ban. My job is to provide the information to the citizens of this country, to elected officials, to businesspeople. Hopefully, armed with the right information, they'll make prudent decisions on behalf of those that they represent or their family members.

Many states have smoking bans

Dr. Richard Carmona

U.S. Surgeon General

People get a false sense of security that the ventilation system is going to keep the smoke out of other areas. Air conditioners, humidifiers will help. They don't. The science in this report shows that you cannot adequately sanitize the air.

JIM LEHRER: Well, there are already many, many localities, counties, states that have smoking bans in public places.

DR. RICHARD CARMONA: Yes, yes.

JIM LEHRER: Is there any evidence that that works?

DR. RICHARD CARMONA: Well, in fact, creating smoke-free workplaces or recreation places does work. The mechanism by which you do that is probably less important than the fact that you've created a smoke-free place.

Now, many communities have come together, and they just said, "You know what? Our office building, we're not going to tolerate smoking." It didn't require legislation; it didn't require a law. People got together, businesses got together and said, "No more smoking here."

But other communities, New York City and others, have decided to put into place policy, government policy, legislation to do that. The goal for me is to make sure we continue this movement to have smoke-free environments.

How it's accomplished, we hope the communities will make the best decision on behalf of the people they represent.

JIM LEHRER: I notice that you even object to these little smoke-free rooms that some airports have and some public places have. That even...

DR. RICHARD CARMONA: Well, let me tell you why.

JIM LEHRER: I don't mean smoke-free. I mean "smoke allowed" rooms, is what I mean, yes.

DR. RICHARD CARMONA: Well, the problem with those is people get a false sense of security that the ventilation system is going to keep the smoke out of other areas. Air conditioners, humidifiers will help. They don't. The science in this report shows that you cannot adequately sanitize the air so that you can protect others in the environment.

JIM LEHRER: So you're in an airport waiting room, and there's a glass-enclosed room where people are in there smoking, and you walk by, you're jeopardizing your life?

DR. RICHARD CARMONA: It's not so much jeopardizing your life, but the door opens, people come in and out. The smoke in that room comes out.

It may be less than the person standing outside, but what's the cumulative effect of 20 or 30 smokers in a small room when the door opens and the smoke comes outside? What about the ventilating system that circulates those toxic materials around?

Even small exposure, just a few minutes of exposure, begins cellular changes that start to harm your cells.

Studies show biochemical changes

Dr. Richard Carmona

U.S. Surgeon General

Scientists have clearly looked at this at a biochemical and cellular level to see what changes -- how long does it take for you being exposed before your blood cells start to act differently. Platelets start to clot.

JIM LEHRER: Now, how do you know that, a few minutes' exposure to somebody else's smoke?

DR. RICHARD CARMONA: Scientists have clearly looked at this at a biochemical and cellular level to see what changes -- how long does it take for you being exposed before your blood cells start to act differently. Platelets start to clot. The lining of your arteries starts to change.

Just a few minutes of exposure begins that. Now, that doesn't mean you're going to get a heart attack or cancer, but you're starting the clock ticking toward a development of chronic disease, which is all preventable if you don't have the exposure to secondhand smoke.

JIM LEHRER: Two examples that most people who don't live in completely smoke-free environments have to deal with. You go into a restaurant or a bar, and there's a smoking section, and you're sitting in the non-smoking section. Are you clean? Are you clear?

DR. RICHARD CARMONA: No, you're not. In fact, the report will provide evidence that says these kind of arrangements are really relatively ineffective in protecting nonsmokers, because the smoke and the toxins move across the room. They circulate.

In fact, in some buildings, the circulation itself is going to move. Air conditioning and fan will move around that particular environment. So you shouldn't get that false sense of security that you're protected because somebody said this is a smoke-free area and the smokers are next to you.

JIM LEHRER: All right, other example. You work in a smoke-free building. For whatever reason, smoking is not allowed in the building, so the smokers have to go outside. And they hang out in an area by the doors and all of that. You go out and walk through them to go outside to do something, is that a problem?

DR. RICHARD CARMONA: It is a problem, because you're still, even for a short period of time, going through an area that has concentrated smoke if you're walking through smokers. We are thankful that they're out of the building and outside, but they really should be away from any areas where there's going to be pedestrian traffic of nonsmokers, to minimize the exposure to those people.

JIM LEHRER: Let's back up a moment.

DR. RICHARD CARMONA: OK.

JIM LEHRER: In general, is smoking continuing on a decline on a percentage basis in the United States?

DR. RICHARD CARMONA: In general, we've made some great stride. You know, my predecessors, beginning with Luther Terrier in 1964...

JIM LEHRER: He's the guy who started it all.

DR. RICHARD CARMONA: ... 1964, the first surgeon general's report on smoking. And I'm putting out the 29th surgeon general's report on smoking 40-plus years later. We still have almost a half of million people a year dying, and it's the most preventable cause of death in this country, is tobacco-related death.

But we have every reason to be somewhat reassured that the trend continues, that smoking is decreasing in most populations, that certain areas of morbidity and mortality are dropping. But we can't be complacent; it's still a very big problem in society.

New forms of therapy to help quit

Dr. Richard Carmona

U.S. General Surgeon

As you look at minority populations, Anglo-populations, Native Americans, you'll see blips where it isn't decreasing enough and you'll see others where it is. The important point is: Even 4,000 to 5,000 children a day is too much.

JIM LEHRER: Where is major problem? Where is most of the smoking beginning?

DR. RICHARD CARMONA: Well, smoking begins with children. We have almost 5,000 children a day begin smoking in the United States, and half of them will continue as chronic smokers.

JIM LEHRER: Explain that. I mean, how could anybody who is alive and alert not know by now that -- and it goes back to 1964 -- that smoking will kill you? What is it that drives people still to smoke, to start smoking?

DR. RICHARD CARMONA: Well, I think most young men and women who are smoking start as youngsters, as teenagers, especially. And once they get hooked on that habit, it's very difficult to break.

Often they start because of peer pressure. My friends do it. It looks cool. My favorite star on TV does it. In the movies, they show the hero with the cigarette in his mouth. All of those things contribute.

But once they get started, then they're at great risk for continuing. As I said, the numbers show that. So what we have to do is stop them from starting in the very beginning; parents, teachers, educators all have to take an active role in this.

JIM LEHRER: And has there been a lot of progress in that area? Are fewer kids percentage-wise starting today than were years ago?

DR. RICHARD CARMONA: In some of the populations. As you break out our populations and you look at minority populations, Anglo-populations, Native Americans, you'll see blips where it isn't decreasing enough and you'll see others where it is.

The important point is: Even 4,000 to 5,000 children a day is too much.

JIM LEHRER: What's the progress report on quitting, those who are hooked and decide for whatever reason, health reasons or whatever, decide, "I've had it, I'm going to quit"? Is there any news there, good news?

DR. RICHARD CARMONA: Well, there's good and bad news. The fact is, is that new forms of therapy continue to emerge. Coupled therapy, that's with behavioral counseling, as well as pharmacologic therapy, seems to work for some people. So there's an array of options.

JIM LEHRER: Take some drugs that will...

DR. RICHARD CARMONA: Exactly, the patches, things like that.

JIM LEHRER: Patches.

DR. RICHARD CARMONA: But you need get to a specialist who understands that, because one size doesn't fit all. So we're getting better, but the failure rate is still pretty high, and it takes sometimes two or three or four tries before somebody finds the right combination so that they can quit.

JIM LEHRER: Smoking is still a serious problem in the United States of America, that's your message?

DR. RICHARD CARMONA: Yes, sir, it sure is. And stay away from secondhand smoke. There's no safe amount of secondhand smoke, and it will hurt you.

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